Healthcare Provider Details

I. General information

NPI: 1871437988
Provider Name (Legal Business Name): NAN CHENG MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 NEWPORT BLVD STE 440
COSTA MESA CA
92627-3786
US

IV. Provider business mailing address

1640 NEWPORT BLVD STE 440
COSTA MESA CA
92627-3786
US

V. Phone/Fax

Practice location:
  • Phone: 949-431-6794
  • Fax: 949-539-8997
Mailing address:
  • Phone: 949-431-6794
  • Fax: 949-539-8997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NAN CHENG
Title or Position: CEO
Credential: MD
Phone: 949-431-6794